Monday, August 24, 2009

Birth Challenges

I've posted several times about the challenges being experienced by homebirth midwives in Australia (legislation has effectively rendered them illegal). Here is a clip from the "Aussie Labor Party" about this topic--love that the speaker refers to the political maneuvers used as "putting a bit of rancid ham in the legislative sandwich." He is a great speaker with lots of passion and great things to say about midwifery and homebirth being "snuffed out" by "sneaky legislation." Another good quote: "There's nothing illegal about homebirthing, but it is about to become that way under this lazy government." (hat tip to The Unnecesarean for the link to the video via Facebook):

Returning to US birth challenges, a well-known midwifery/homebirth supporter, Dr. Stuart Fischbein, is being threatened with sanctions and removal of privileges for supporting women in having VBACS and breech births. You can keep up with his situation on his blog.

Tying the two together thematically, is an excellent article from Dr. Marsden Wagner from 2000, that is a very accurate assessment: Fish can't see water. My favorite quotes from this article are as follows:

But we do not have humanized birth in many places today, including Australia. Why? Because fish can't see the water they swim in. Birth attendants, be they doctors, midwives or nurses, who have experienced only hospital based, high interventionist, medicalised birth cannot see the profound effect their interventions are having on the birth. These hospital birth attendants have no idea what a birth looks like without all the interventions, a birth which is not dehumanized. This widespread inability to know what normal, humanized birth is has been summarized by the World Health Organization:

"By medicalising birth, i.e. separating a woman from her own environment and surrounding her with strange people using strange machines to do strange things to her in an effort to assist her, the woman's state of mind and body is so altered that her way of carrying through this intimate act must also be altered and the state of the baby born must equally be altered. The result it that it is no longer possible to know what births would have been like before these manipulations. Most health care providers no longer know what 'non-medicalised' birth is. The entire modern obstetric and neonatological literature is essentially based on observations of 'medicalised' birth." - World Health Organization[1]

Why is medicalised birth necessarily dehumanizing? In medicalised birth the doctor is always in control while the key element in humanized birth is the woman in control of her own birthing and whatever happens to her.

I think these observations are key. We have a majority of people in industrialized countries who do not know what normal birth looks like. Fear-based recommendations are then made for maternity care based on a "lens" of birth that only includes intervention and and interference.